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Pharmacology > Dementia > Flashcards

Flashcards in Dementia Deck (41):
1

Dementia

an acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert person, usually behavioral disturbances too

2

Diagnosis of dementia

DSM-V-TR, spouse, rating scales, autopsy, brain atrophy and neuronal loss (dec acteylcholine)

3

Risk factors of dementia

age, fam hx, hx of head trauma

4

Alzheimer's disease

60-70% of all dementias, presence of B-amyloid and tau proteins, slow, progressive decline in cog ability, initial impairment w/ short term memory, difficulty learning new info, aphasia, impaired visuospacial fct

5

Lewy Body Dementia

Lewy body plaques, limbic and neocortical areas outside the substantia nigra, presents w/ fluctuations in alertness/attentian and confused states, visual hallucination are common, parkinsonia, orthostatic hypoTN, syncope

6

Vascular dementia

abrupt onset with stepwise, causal decline in cog function, based on vascular insults, language and memory retrieval difficulties, symptoms largely reliant on location of injury

7

parkinson's dementia

pts w/ parkinson's have 6x chance of dementia diagnosis, motor disturbances accompanies and often precedes symptoms, gait dysfunction, visual disturbances, frequent falls

8

What should you avoid when possible

antihistamine, oxybutnin, tolterodine, cyclobenzaprine, TCAs

9

AD treatment of cog sx

acetylcholinesterase inhibitors, NMDA antagonist

10

AD treatment of BPSD

non-pharm therapy, antipsychotics, antidepressants, antionvulsants/ mood stabilizers, benzos

11

Non-pharm treatment

exercise body/brain, mediterranean diet, music, orientation reinforcement, communication, attention to safety

12

Basic principles of care for AD

Keep requests and demands simple, avoid confrontation, remain calm, firm, supportive, frequent reminders, explanations, orientation cues, adjust to expectations, patience!

13

AChEI aimed to

increase acetylcholine, correct the cholinergic deficiency hypothesis of amnesia

14

Nucleus basalis of meynert

located in basal forebrain, principle site of cholinergic cell bodies for axons that project to the hippocampus, amygdala and throughout the neocortex, it is the degeneration of these cells that leads ot AD

15

MOA of AChEI

inhibit acetylcholinesterase, inhibit degradation of acetylcholine and thus increase acetylcholine concentrations in nerve synapses, doesn't affect underlying neurodegenerative process

16

Efficacy of AChEIs

most effective when started early, used for mild to moderate, and moderate to severe AD; may see benefit for 1-3 years

17

ADRs of AChEIs

nausea, vomiting, diarrhea, wt loss, can exacerbate GI bleed

18

AChEIs

Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne), combo Donepezil/Memantine (Namzaric)

19

Donepezil (Aricept)

better tolerated and more convenient dosing, indicated for mild to severe AD, CNS selective, reversible inhibitor of AChE

20

Dosing of Donepezil (Aricept)

5 mg qHS for 4-6 weeks, then increase to 10 mg qHS

21

Rivastigmine (Exelon)

less tolerable compared to donepezil, less DI, CNS selective, pseudo-irreversible for AChE and BuChE, mild to severe AD and Parkinson's dementia, hard on GI

22

Rivastigmine (Exelon) patch

less GI SE, better for compliance, 4.6mg/24 hours (4 weeks, can titrate up) and 9.5mg/24 hours

23

Galantamine (Razadyne)

reversible, competitive AChEI, more DIs, 3A4 & 2D6 metabolism, should not be used in severe renal and hepatic impairment, mild to moderate disease

24

Memantine (Namenda) effects

block Ca entry when extracellular glutamate is low, allows intracellular Ca levels to return to normal, when glutamate is increased in response to an action potential, glutamate displaces memantine, causing brief Ca entry

25

Pathophysiolody of NMSA receptor in AD

activated state, slow but steady leakage of glutamate from the pre synaptic neuron keeps the NNMDA receptor in constantly activated state allows excess influx of Ca which leads to persistant neuroexcitation and cell death

26

Memantine (Namenda) therapy

renally eliminated, ADRs: constipation, dizziness, HA, confusion, agitation, HTN; for mod to severe AD most often in combo w/ AChEI, 10 mg BID

27

Memantine/ Donepezil (Namzaric)

mod to severe AD, 10 mg donepezil+ memantine 10 mg BID or 28 mg once daily

28

Vitamin E

possiple protective effects, recent results of meta analysis suggests increase in all cuase mortality when dose >400 IU/day

29

Ginko Biloba

antioxidant properties, questionable effectiveness, shown to stabilize of improve cog performance and social behavior for 6-12 months w/ uncomplicated AD, also antiplatelet effects (caution)

30

Anti-inflammatory agents

epidemiological studies suggest possible protective effect by dec B amyloid plaque development, long term risks

31

Lipid lowering agents

possible protective effect, statins dec B amyloid production in vitro, generally not recommended outside of reducing cholesterol

32

Treating lewy body dementia

AChEIs considered DOC, avoid typical and atypical antipsychotics

33

Treating vascular dementia

control vascular risk factors, HTN, DM, hyperlipidemia, PVD, stop smoking, AChEIs DOC

34

Treating Parkinson's dementia

AChEI show improvement in cognition, alertness, apathy, and aggression, may need to inc antiparkinsonian medications, can try memantine

35

Common behavioral symptoms

psychotic, delusions, hallucinations, inappropriate behaviors, agitation, wandering, sexual behaviors, depression

36

Treating BPSD non pharm

identify behavior, understand cause, adapt environment, remove triggers, orientation, treat pain, clear infections

37

Adverse effects of antipsychotics

falls, fractures, delirium, oversedation, stroke

38

approach to treatment of BPSD

reserve until non-pharm has failed, initiate low doses, monitor closely for efficacy, work w/ pt and caregiver to individualize and simplify the drug regimen, should not be long term

39

Antipsychotics useful for

temporary agitation and delirium/psychosis

40

Haloperidol (Haldol)

PO/IM, blocks post synaptic mesolimbic D1/D2 receptors, ADRs: extrapyramidal symptoms, QT prolongation, sedation, works quickly, not for parkinson's

41

Boxed warning with Haloperidol

increased risk of death